Anesthetic Neurotoxicity: A Difficult Dragon to Slay

It has become difficult to open an anesthesiology journal without seeing an article about anesthetic neurotoxicity. This issue ofAnesthesia & Analgesia is no exception. Most of the work has been done in animals and suggests that harm can come to the developing brain when it is exposed to a broad array of commonly used anesthetic and sedative agents. The critical question, of course, is, does it happen in children? DiMaggio et al., in this issue of the Journal, approach this by using an administrative database of siblings to determine whether anesthesia and surgery in the first 3 years of life are associated with subsequent developmental or behavioral disorders. Their study shows that children exposed to anesthesia and surgery have a much greater likelihood of being diagnosed with a developmental or behavioral disorder than do unexposed children, but that within a matched twin pair, in which one sibling was exposed to anesthesia and surgery and the other was not, there was no greater risk of an adverse outcome. This clearly adds new information to the literature. But can this answer the question, “are anesthetics neurotoxic in children?”